Pain Management In The Elderly

GENERAL INFORMATION:

What is pain?

• Pain is an unpleasant feeling and emotional experience related to injury or damage to the body. This is one of the most common complaints that remains poorly treated in the elderly. An older person may be called an elder. There is no set age for an elder, but it may be defined as when a person retires at the age of 60 or 65 years old. In certain countries, it may be when a person physically cannot do his usual family or work roles anymore.
  
  
• As you become older, different changes occur in your body and how it works. Elder people may have more health problems but this does not make pain a normal part of aging. Pain may be a sign that something is wrong with your body. The body contains special cells that receive signals when there is damage or injury to the body. These cells send a message to the brain. When the brain receives the message, you will feel pain.

What are the types of pain?

• Acute pain: This occurs when the body tells the brain that something is wrong, such as an illness or injury. It comes on suddenly and does not last for a long period of time. This usually goes away as your body heals, but may lead to chronic pain if left untreated.
  
  
• Chronic pain: This type of pain persists or grows worse over a long period of time. It may last for months or years due to a chronic (long term) condition. It may be pain that remains after you have recovered from an injury or illness. Chronic pain may persist even if caregivers have given you medicines or treatments. It may not always be present but still may cause problems with your daily activities.

What causes pain in the elderly? Pain is often caused by more than one problem. These problems may include damage to the nerves or tissues, such as skin, muscles, and internal organs. Sometimes, there is no clear or exact cause of pain. Any of the following may cause or trigger pain:

• Diseases, such as cancer, arthritis, migraines, and back problems.
  
  
• Physical injury, such as with surgery, accidents, or falls.

What other things should elderly people know about pain? All pain should be treated and can almost always be relieved. Elder people often have many questions and fears about pain. These fears may make them not seek treatment to relieve their pain. The following are important things that you should know about pain and its management:

• Do not be ashamed to tell your caregivers about what you are feeling.
  
  
• Controlling your pain is part of the whole treatment for your disease.
  
  
• Pain medicines are not only for terminal diseases such as cancer and will not make you doped up or lose control.
  
  
• Side effects from medicines can often be prevented and managed properly.

How can caregivers know if an elder is in pain? Elders who can talk clearly may tell exactly the location, intensity (how bad), and even the duration of the pain. Some elders who have certain diseases or injuries may have trouble saying what they really feel. These diseases may include dementia (memory problem), brain damage, or a stroke. You may even deny that you are having pain to show courage or escape treatment. The following are common signs that may tell caregivers that you are in pain:

• Crying, moaning, frowning, or sighing.
  
  
• Feeling sad, depressed, hopeless, aggressive, or angry most of the time.
  
  
• Noisy breathing, calling out, or asking for help.
  
  
• Not changing positions very often to avoid pain, or positioning yourself in a way that it will not hurt.
  
  
• Poor appetite and eating habits, or sleeps more or sleeps less than usual.
  
  
• Pulls the part of the body that is hurting or gets upset at being touched.
  
  
• Restlessness, cannot get comfortable, and moves around a lot.

How is pain diagnosed? It may be easier to diagnose your pain if you have a pain diary. A pain diary helps track pain cycles, and makes you more aware of when and how the pain may start and end. Elder people may often describe pain as slow, dull and achy. No tests are available to diagnose pain. Caregivers may first look for possible causes of your pain. The diagnosis of pain is based on how long and how often you have your symptoms. You may also need any of the following to check how much pain you have or find its cause:

• Physical examination: Your caregiver will look for painful areas during a physical exam. He may touch, press, or stroke different places on your body.
  
  
• Imaging tests: Caregivers may suggest that you have different imaging tests to look for the cause of your pain. These may include x-rays, computed tomography (CT) scan, and magnetic resonance imaging (MRI).
  
  
• Pain scale: These are special tools that can help caregivers measure how much pain you feel. There are many pain scales that include numbers or cartoon faces with different expressions. Your caregiver may ask you to rate the pain on a scale of 0 to 10.
  
  
• Stimulation tests: Stimulation tests tell exactly which nerves or muscles are affected by pain.

How is pain treated? The aim of pain management in the elderly is to relieve pain and improve your quality of life. Controlling pain may allow you to work or do your usual activities. Caregivers may need to treat your pain and its cause by giving you medicines. These medicines work by blocking pain signals going to the brain or by changing how the brain interprets pain signals. Almost all types of pain can be controlled. Work together with your caregiver to decide the best pain control treatment for you. You may need one or more of the following:

• Analgesics: This is a group of medicines that includes most painkillers.
  
  
  • Narcotic analgesics: These medicines, which include morphine, contain opium. A narcotic analgesic is used for moderate to severe (very bad) pain. This may be used to control cancer pain or after having surgery or other procedures.
    
    
  • Non-narcotic analgesics: These work by changing the way the body senses pain and by cooling the body. Non-narcotic analgesics are used to relieve mild to moderate pain from headaches, muscle aches, colds, and fever.
    
    
  • Non-steroidal anti-inflammatory drugs: This family of medicine, also called NSAIDs, helps decrease pain and inflammation (swelling). Some NSAIDs may also be used to decrease a high body temperature.
  
  
• Anesthesia: This numbing medicine is used to control pain and make you comfortable during a procedure or surgery.

What other medicines may be given to help you with your pain? Your caregiver may also need to treat the cause of your pain. Pain caused by infections may be treated with antibiotic or anti-viral medicine to kill the germs. Pain from cancer may be treated with chemotherapy or radiation therapy. Your caregiver may suggest other medicines to help control your pain, or prevent the side effects of pain medicines.

• Anti-anxiety medicine: This medicine may be given to help you feel less nervous and more relaxed.
  
  
• Anticonvulsant medicine: Anticonvulsants are given to control seizures.
  
  
• Anti-depressants: These medicines may be used to help decrease or prevent depression. Anti-depressants lift up your mood and may help relieve your pain.
  
  
• Muscle relaxers: This is medicine to help your muscles relax. When your muscles relax, you may move more easily and have less pain.
  
  
• Radiopharmaceuticals and biphosphonates: Radiopharmaceuticals and biphosphonates help decrease cancer growth, pain, and inflammation that happens when cancer gets inside bones.
  
  
• Sedative: A sedative medicine may be given to help you stay calm and relaxed.
  
  
• Steroids: Steroid medicine may be given to decrease inflammation, which is redness, pain, and swelling.

What are other ways of treating pain? Aside from medicines, treatment of pain may include any of the following:

• Complementary and alternative therapies:
  
  
  • Acupuncture: Acupuncture is a treatment based on a belief that our bodies have channels through which fluids flow. Caregivers will insert very thin needles just under your skin. This is believed to open the channels allowing fluids to flow better. This treatment may decrease pain and improve healing. Always see a caregiver for this treatment. Do not try to give this treatment to yourself.
    
    
  • Aromatherapy: Essential oils, extracts, or fragrances from flowers, herbs, and trees are used. These may be smelled or applied for massage, facials, body wraps and baths. Aromatherapy helps you relax and relieve stress.
    
    
  • Chiropractic therapy: Pain is treated by caregivers who move body parts in certain ways. This may include parts such as the spine (backbone) and joints. Joints are places on the body where two bones meet, such as the elbows or knees.
    
    
  • Dietary supplements: Vitamins, minerals, herbs, or other botanicals (plants) may be given to ease pain.
    
    
  • Mind-body therapies:
    
    
    • Biofeedback training: Biofeedback is a special way to control how your body reacts to things like stress or pain. The first step in this training is to use electrodes (wires) to monitor your body responses. These electrodes are placed on different parts of your body, such as your chest. The electrodes are attached to a TV-type monitor which gives a paper tracing of your heart beating. You will learn how to control body changes, such as slowing your heart rate, when you become upset.
      
      
    • Hypnosis: This is done by putting you in a trance-like (sleep-like) state. Your caregiver then gives you suggestions that may help you heal yourself.
      
      
    • Meditation: This therapy teaches you how to focus inside yourself. The goal of meditation is to help you feel more calm and peaceful.
      
      
    • Relaxation therapy: Relaxation therapy teaches you how to calm your body and mind. The goal is to feel less physical (body) stress and have less emotional (mind) stress.
  
  
• Education: It is important that you know and understand your condition, treatment, and care. This will allow you to tell your caregivers how you really feel about your pain. You may also talk about your concerns, such as becoming addicted (dependent) to pain medicines. Your questions or fear of the side effects and costs of medicines and other treatments may also be explained. Pain may be decreased or relieved by believing that you can control and handle pain.
  
  
• Electrical stimulation: A special device is used that sends mild and safe electrical signals. These signals decrease your pain when used over a painful body part.
  
  
• Heat and cold application: Some types of pain are decreased by using warm or heat packs while others improve with cold. Your caregiver will tell you if warm or cold packs, or both used alternately, will help your pain. Taking a warm bath may also help your muscles relax. A cool shower on a very hot summer day may also relax tense muscles.
  
  
• Rehabilitation: This program may include physical and occupational therapy. With physical therapy (PT), special exercises are used to help your body get stronger and heal faster. Caregivers may suggest that you use special assistive devices, such as a wheelchair, braces, crutches, a cane, or a walker. Using these devices may decrease stress and strain on your back and muscles. Massage and physical therapy can be even more effective if you also use guided imagery, breathing exercises, or music. Occupational therapy (OT) uses work, self-care, and play activities to help you in your daily life. These include special skills for bathing, dressing, cooking, eating, and driving.
  
  
• Surgery and other procedures: Your caregiver may do surgery to help relieve your pain. He may need to remove the whole or a part of a tumor. He may also cut nerves or remove joints that may be causing your pain. He may use ultrasound, radio waves, thermal (heat), or laser therapy to relieve your pain. Ask your caregiver about these different treatment options for cancer pain.

What might happen if pain is not treated? Pain may affect many areas of your life. It can affect your appetite (ability or desire to eat), how well you sleep, your energy and your ability to do things. It can also affect your mood (how you feel about things) and your relationships with others. It is sometimes hard to find the cause of pain. You may feel that it is impossible to get rid of your pain. This can cause a cycle of suffering, sleeplessness and sadness. If caregivers can help control your pain, you will suffer less and enjoy your life more.

Where can I find more information? Having pain when you are an elder may be hard for you and your family. Accepting that you have pain may be hard. You and those around you may feel sad, frightened, and anxious. These feelings are normal. Talk to your caregiver, family, or friends about your feelings. Contact the following for more information about pain:

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS 66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

• National Chronic Pain Outreach Association
  PO Box 274
  Millboro, VA 24460
  Phone: 1-540-862-9437
  Web Address: www.chronicpain.org
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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